A Case-Based Approach to the Ethical and Policy Issues Raised by Living Donor Transplantation

Abstract:
The purpose of the research is to explore the ethical and policy issues raised by transplantation with living donors. While the major ethical and policy issues in living donor transplantation depend, in part, upon the organs and tissues being procured, there are certain cross-cutting themes that relate to any living organ or tissue procurement, including: 1) the moral agency of living donors and their prospective recipients; 2) how much risk living donors should be allowed to take; 3) what informed consent means and requires in the context of living donation; 4) the limits to privacy and confidentiality between living donors and recipients; 5) whether and when members of vulnerable populations can serve as living donors; 6) the moral limits to donor recruitment; 7) whether there should be restrictions on who can receive a live donor organ or tissue; 8) public policy regarding payments to donors, whether for expenses or as incentives; and 9) justice issues and disparities in living donor transplantation. This project will explore these themes using case studies. Our use of case studies is innovative because we seek to bridge the gap between ethical theory and clinical practice to reform living donor transplant policy, an area relatively neglected and lacking much regulatory oversight. The case study format will allow us to engage the myriad of stakeholders involved in living donor transplantation decisions. We will use cases and an analytical framework based on respect for persons in a process of “reflective equilibrium” in which one works back and forth between one’s moral intuitions and judgments with the particularities of the case to identify the principles or rules that explain one’s judgments, revising the judgments or principles whenever necessary in order to achieve an acceptable coherence among them. This approach uses analytical moral philosophy responsive to the clinical facts and the social and historical context, with the aim of creating a morally sound, clinically useful framework that provides guidance in transplant practice and policy development and refinement. The principal product of the research will be a book analyzing over two dozen cases.